Accepted for/Published in: JMIR Formative Research
Date Submitted: Apr 17, 2020
Date Accepted: Mar 3, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
E-learning for instruction and to improve reproducibility of scoring the tumor-stroma ratio in colon carcinoma; the UNITED study
ABSTRACT
Background:
The amount of stroma in the primary tumor is an important prognostic parameter. The tumor-stroma ratio (TSR) was previously validated by international research groups and showed to be a robust prognostic parameter for disease prognosis with good interobserver agreements.
Objective:
The UNITED study (Uniform Noting for International Application of the Tumor-stroma ratio as Easy Diagnostic tool) is developed to bring the TSR to clinical implementation. As part of the study, an E-learning module was developed to confirm the reproducibility of scoring TSR after proper instruction.
Methods:
The E-learning module consisted of an auto-instruction for TSR determination (instruction video or written protocol) and three sets of 40 cases (training-, test- and repetition set). Scoring the TSR is performed on haematoxylin and eosin stained sections and takes only 1-2 minutes per case. Cases are considered stroma-low if the amount of stroma is ≤50%, stroma-high is defined as >50% stroma. In the present study, inter- and intra-observer agreements were determined after each set to evaluate the reproducibility.
Results:
Pathologists and pathology residents (n=63) with special interest in colorectal cancer participated in the E-learning. Forty-nine participants started the E-learning, thirty-one (63%) finished the whole cycle (3 sets). A significant improvement was seen from training set to test set; median kappa improved from K=.72 to K=.77 (p=.002).
Conclusions:
E-learning is an effective method to instruct pathologists and pathology residents for scoring TSR. The reliability of scoring improved from the training to the test set and did not fall back with the repetition set, confirming the reproducibility of the TSR scoring method. Clinical Trial: The UNITED study is registered in the Netherlands Trial Registry (NTR 7270). http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=7270
Citation
The author of this paper has made a PDF available, but requires the user to login, or create an account.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.